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Diabetes: Silent killer on the prowl •How many people dig their graves with their mouths

As the world marks yet another year of drawing awareness to diabetes, a disease that has killed millions of people and is still wreaking havoc TADE MAKINDE and NEWTON RAY UKWUOMA look at how the disease can be prevented and managed.

 

IN the 80s, a popular bottling company shocked Nigerians with the first in the series of product promotions that reportedly ended up affecting Nigerians negatively. Back then, many who wanted to win free cars, houses, cash, T-Shirts, amongst other items, consumed many bottles of a brand of the company’s products,  reportedly resulting in the rise of diabetic patients in the country.

Sometime in 1973, Mr E.A Adeyinka, whose favourite drink was Eggovin, drank two bottles of the product at a social gathering in Ekiti. When he got back to Ibadan, he began to feel ill. He thought it was fever until a test revealed that his insulin level had shot up. He was told he had diabetes.

Batode Akinola, told Sunday Tribune that his late father told him that his late mother’s great grandfather’s path to the farm was allegedly laced with juju in the 20s and since then, the man’s children, grandchildren have been diabetic. “Diabetes killed my mother 15 years ago. Since I am told it is hereditary I have made it a point of duty to always check my blood sugar level every three months. I have told my siblings to do same because we watched our mother suffer a lot, just as our father spent his entire life savings and shares to treat her to no avail,” he told Sunday Tribune.

But some people still don’t believe some types of food and/or drinks kill steathily through diabetes.

Mr Samson Aduloju, who spent his entire life smoking and drinking all the brands of beer he could find, died seven years ago at the age of 84. He died in his sleep.

“I don’t understand all this noise about diabetes killing those who drink soft products and beer, when my father was not killed by cancer or diabetes,” Gboyaga Aduloju responded.

A Lagos medical doctor, Dr Richard Ajayi, cannot live a day without two pieces of meat or chicken pie and a bottle of Coke. “I am 77 years now and I don’t have diabetes,” he said.

Tomorrow is World Diabetes Day. It is a day often used to draw attention to patients worldwide and to enlighten others on what could be done to avoid falling victim of the disease.

Diabetes is a condition where the amount of glucose in the blood is too high, because the body cannot use it properly. This is because the pancreas doesn’t produce any insulin, or not enough insulin, to help glucose enter the body’s cells – or the insulin that is produced does not work properly (known as insulin resistance). Insulin is the hormone produced by the pancreas that allows glucose to enter the body’s cells, where it is used as fuel for energy so we can work, play and generally live our lives. It is vital for life.

If one has diabetes, one’s body cannot make proper use of this glucose so it builds up in the blood and can’t be used as fuel.

Except for college study of Biology where diabetes is treated in testbooks, it was not a popular disease until it suddenly broke out after the above-mentioned promotion efforts in the 80s as many other bottling and brewing companies joined in promoting their products among customers.

So, what is it about this silent killer-disease that is affecting about a third of the world and many still have different views of it?

Diabetes, according to Belgium-trained Dr Victor Adeyefa, is simply the loss of sugar in the body. “Bottling, brewing products and some types of food in the tropical regions, in fact, every where in the world, end up in the body as sugar. In Nigeria, most of the foods we have also end up in sugar. Eba, Iyan, Fufu, Yam, Potato, etc, all gets turned into sugar in the body. Even milk from breasts.

“In the body, sugar provides energy for many human activities such as running, walking, engaging in strainous activities, among others. Understanding what it is and how it can be managed is key to the solution to diabetes. If it is as deadly as being said, more than half of the world would be dead by now,” he said.

The former UCH and Teju Memorial Hospital specialist said “the common types of sugars are glucose (all types of foods are converted into glucose), lactose (got from milk) and sucrose (from fruits).

“When sugar is not absorbed into the bloodstream to provide us with the much needed energy, it is lost through urine. The Yoruba people call it Atogbe. The sugar that is needed is passed out and wasted. Without sugar, people will faint or even go into coma. Loss of sugar through urination also leaves one very lean. Most sufferers’ lips are unusually dry and they want to drink water.

“The easiest and surest way to know if one is diabetic is to urinate on the ground and go back there after about an hour. If you see ants on that spot or around it, that is a sure sign of diabetes. Again, Fasting or random sampling blood sugar tests can also be conducted at medical laboratories. You can also taste your urine to know if you have it or not,’ he said.

“Diabetes is caused by the malfunctioning of the pancrease. This can be set on by trauma to the organ, caused by sudden punch to the stomach or accident that affects the stomach. Any sudden impact on pancreas can cause it to malfunction. It is not the consumption of soft drinks or beer or carbonhydrates as many say. Why people blame it on these products is because they are always converted into sugar at the end of the day. But if truly some soft drinks that claim to be sugar free are really free, then its okay to take them. But all soft drinks or beers or stout end up in sugar,” added Dr Ajayi.

Dr Adeyefa said there should be a minimum level-70mg-100mg and 110-150mg of sugar in the body. “Anything above that is not good. That means something is wrong. But what do we eat that’s not going to end in sugar? Even abroad, their foods are converted into sugar. is it their potatoes, rice, bread? That is why it is advised that less of carbohydrates should be eaten, complemented with protein in fish, meat, eggs, soy beans or beans.”

Asked why most patients find it hard to refrain from eating harmful foods, Adeyefa blamed it on habit formation. “Like “As I said, most of our foods are carbohydrate. Many have learned to eat mostly rice, Eba, Iyan and so on. If you are now told to stop eating any of these, it becomes a problem. That is why it is suggested that we should eat small and sparingly. Many hospitals have a list of foods to eat and those to stay away from. You do that, you take your drugs, you will live long.’

On why diabetics’ wounds don’t heal, he said that what should help in healing is urinated. “Pancrease produces Insulin, Insulin converts glucose into body use. Instead of the sugar to go into the body, it is urinated. What should help the blood to clot has been pissed away. The sufferer goes to toilet 5,6,7 or more times overnight. That’s why before any operation is carried out on anybody, urine test is the first thing to be done. If the patient is diabetic, the operation is immediately postponed and the diabetes is treated.

Mr Adeyinka, now 83 years, has been managing diabetes for 43 years. He stopped drinking Eggovin and any brand of soft drink and still drives, washes car, mows gardens, treks, engage in other forms of exercises. “I don’t live a sedentary life and will not advise anyone to ,because it can cause diabetes. Our forefathers trekked a lot. Instead of urinating the sugar in their bodies away, they sweated it out. That way, the quantity of sugar needed is absorbed in their body.

“Many drop dead and we say it is ‘aiye’ that killed the person. It was not until I was confirmed diabetic that I believed it had nothing to do with any spiritual attack. I don’t advise that people should use traditional drugs or herbs because it is immeasurable. People just drink and drink, eventually damaging their kidneys and pancrease ending up in renal failure. It is caused by our lifestyle. For me, I have been obedient to the rules and that is eat less, drink anything that is not water less and excercise more.”

Adeyinka, the Oyo State chairman of the Diabetes Association of Nigeria, also said that many suffer the ailment, but they don’t know it. In Ibadan where the association has engaged in a month-long activities marking the World Diabetes Day, random tests conducted on many market women at Bodija, Oja Oba, and others showed that, many had it and they didnt know. Last year, a two-year-old girl had it. That’s how bad it has got.” As regards the two-year-old girl, Dr Ajayi said she would have contracted it from her mother during pregnancy.

Adeyinka, who also prides himself on not having had any member amputated disclosed that, in many teaching hospitals, you have many people whose legs or arms have been cut. This does not have to be if people are obedient.

“There are four stages of diabetes. The Type 1 and 2 can only be handled by careful management of the disease. Pregnant women and small children also are prone to diabetes, but that can be dealt with without much regulations. All said, awareness is what can save anyone suffering diabetes, because it’s all about what we eat.” There is, however, a snag. His association relies mostly on support from individuals and private organisations. “Governments have not helped us much. A governor in the past instructed that the association should be given N500,000 annually to organise transportation, feeding and other logistics for awareness programmes on the dangers of careless lifestyles that could result in diabetes. The official in charge of the ministry said we should sign a paper that we have collected the money, but nothing was given us till he was sent packing from government house.

“Another governor approved N1.8m. Till date, we have not been given anything. Over 2 million people have diabetes in Oyo State alone and what we use to create awareness has been what Bovas Charitable Organisation, St Annes Church, Molete, Chapel of Resurrection, U.I, U.I Central Mosque, UCH Central Mosque and Arisekola Mosque have been helping us with. We have instructed our national president, Alkali, to let the president know that duty on drugs should be removed so that they can be affordable for many. 10 mills of Insulin is N4,000 now. It was N1,500 before. We need a rebate.

 

Symptoms?

Walking becomes more difficult

Applying or wearing shoes becomes more difficult

Tingling sensation or pins and needles

Part or all of your foot becomes swollen

Breaks in the skin, opens sores/blisters or a discharge

Skin colour changes (redder, bluer, paler, blacker) over part or all of the foot

Swelling in your feet and/or an unusual odour

Part or all of your foot feels much hotter or colder than usual

Hard skin (callus)

Cramp in your calves

Shiny smooth skin and/or losing hair on your feet and legs.

 

Management

Diabetes mellitus is a chronic disease, for which there is no known cure except in very specific situations. Management concentrates on keeping blood sugar levels as close to normal, without causing low blood sugar. This can usually be accomplished with a healthy diet, exercise, weight loss, and use of appropriate medications (insulin in the case of type 1 diabetes; oral medications, as well as possibly insulin, in type 2 diabetes).

The National President of Diabetic Association of Nigeria (DAN), Dr Alkali Mohammed, in reacting to the increasing cases of gangrene and lower limb amputation associated with most diabetic patients revealed that one out of every ten patient in Nigeria will experience such complications.

He said that the sensations in the leg and swollen feet were normal signs of diabetics arising from the concentration of sugar in the bone marrow. He, however, noted that these signs may not lead to gangrene, death of body tissues due to insufficient blood supply, or limb amputation.

“In most cases small injuries lead to bacterial infections which, when not properly treated, might aggravate to gangrene. And in the late stage of gangrene, patients will be advised on amputation,” he said.

Also speaking on measures for preventing leg infection, Mohammed insisted on strict attention to sugar level management. He also highlighted the importance of early treatment of every infections and role of hospital in managing podiatric conditions.

“Diabetic patients must monitor their blood sugar in order to control complications that may arise due to leg infection. They should inspect their feet regularly. Every injury must be treated aggressively before it develops into gangrene.

“Also, care of the feet, podiatry, should receive a lot of attention in our hospitals. This is an aspect of medicine that is not given prominence in Nigeria. We cannot have comprehensive diabetic clinics in Nigeria without podiatry.”

Similarly, Dr Felix Faniran, the former National President of the Nigerian Union of Allied Health Professionals, emphasised on the education of patients across the nation on the basic precautions and information about diabetics.

He inferred that proper education on the lifestyle choices that are associated with diabetics will ensure that patients are not ignorant of complications such as leg infections.

“Diabetics is a situation of excess sugar in the blood. When diabetic patients get injured, the body is exposed to bacteria, which feed on the sugar in the blood. This makes it extremely difficult for wounds sustained by a diabetic patient to heal. The feet is majorly the vulnerable member of the body when it comes to injuries so that diabetics most times have leg wounds which do not heal easily. This may lead to great health complications for the patients.

“And patients need to be educated especially about some basic precautions to be taken to ensure an effective control of the diseases.

“This is why we encourage patients to join the Diabetic Associations at both the state and national levels in order to get information about effective management and proper education about the disease.”